Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.00 / $103.72 / $514.12	Professional		$73.00	$103.72	$514.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.70 / $20.76 / $39.52	Professional	26	$15.70	$20.76	$39.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.53 / $72.98 / $135.22	Professional	TC	$43.53	$72.98	$135.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.96 / $90.92 / $148.19	Professional		$37.96	$90.92	$148.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $24.23 / $36.95	Professional	26	$10.96	$24.23	$36.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.77 / $66.68 / $109.85	Professional	TC	$24.77	$66.68	$109.85
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $81.84 / $169.52 / $241.62	Professional		$81.84	$169.52	$241.62
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $18.59 / $38.51 / $54.89	Professional	26	$18.59	$38.51	$54.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $63.25 / $131.01 / $186.74	Professional	TC	$63.25	$131.01	$186.74
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $111.86 / $162.50 / $272.67	Professional		$111.86	$162.50	$272.67
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.95 / $40.86 / $61.53	Professional	26	$30.95	$40.86	$61.53
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.91 / $121.55 / $211.13	Professional	TC	$95.91	$121.55	$211.13
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $31.49 / $38.51 / $42.88	Facility	26	$31.49	$38.51	$42.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $25.73 / $36.45 / $45.90	Professional	26	$25.73	$36.45	$45.90
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $74.61 / $96.42 / $169.00	Professional	TC	$74.61	$96.42	$169.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $90.92 / $180.18 / $261.52	Professional		$90.92	$180.18	$261.52
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.93 / $24.23 / $37.90	Professional	26	$12.93	$24.23	$37.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $29.29 / $66.68 / $121.16	Professional	TC	$29.29	$66.68	$121.16
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $161.60 / $197.35 / $287.77	Professional		$161.60	$197.35	$287.77
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $35.90 / $42.27 / $63.95	Professional	26	$35.90	$42.27	$63.95
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $125.69 / $155.83 / $223.82	Professional	TC	$125.69	$155.83	$223.82
United Facility/Professional Professional Modifier Low / Median / High Price $59.11 / $98.52 / $284.58	Professional		$59.11	$98.52	$284.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.86 / $13.86 / $63.23	Professional	26	$13.86	$13.86	$63.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $45.25 / $75.42 / $221.36	Professional	TC	$45.25	$75.42	$221.36